Department of Anaesthesiology, The First College of Clinical Medical Science, China Three Gorges University & Yichang Central People's Hospital, Xiling District, No. 4, Hudi Street, Yichang, 443000, China.
BMC Anesthesiol. 2024 Aug 13;24(1):290. doi: 10.1186/s12871-024-02663-x.
Rapid sequence intubation (RSI) have been shown to be effective in preventing reflux aspiration in patients with a full stomach during anaesthesia induction and endotracheal intubation. However, there is currently no standardized operation protocol or anaesthesia induction drug standard for RSI. Furthermore, there is a lack of evidence regarding the use of RSI in patients older than 65. In this study, we aimed to investigate the cardiovascular effects of different doses of alfentanil combined with propofol and etomidate during RSI in elderly patients aged 65-80 years.
A total of 96 patients aged 65-80 years who underwent general anaesthesia with tracheal intubation were selected for this study. The patients were randomly assigned to one of four groups using a random number table. Group A patients received an induction dose of 10 µg/kg alfentanil, group B patients received 15 µg/kg alfentanil, group C patients received 20 µg/kg alfentanil, and group D patients received 25 µg/kg alfentanil. Heart rate (HR), mean arterial pressure (MAP), cardiac index (CI), and ejection fraction (EF) were measured at three time points: 5 min before anaesthesia induction (T0), 1 min after endotracheal intubation (T1), and 5 min after endotracheal intubation (T2). Concurrently, 4 ml of arterial blood was collected from patients at three time points, and the concentrations of norepinephrine (NE) and cortisol (Cor) in plasma were detected. Occurrences of hypertension, hypotension, bradycardia and tachycardia during anesthesia induction to 5 min after tracheal intubation were noted.
Compared with T0, the HR, MAP, NE and Cor concentrations in group A and group B were increased at the T1 and T2 time points, CI and EF values were decreased (P < 0.05). HR and MAP in groups C and D were increased at the T1 time point, while they were decreased at the T2 time point in group D (P < 0.05). The changes in CI and EF values, concentrations of NE and Cor, were not significant at T1 and T2 time points in group C (P > 0.05). Additionally, they were not significant in group D at the T1 time point (P > 0.05), but decreased at the T2 time point (P < 0.05). Compared with group A, the HR, MAP, NE and Cor concentrations in groups C and D were decreased at T1 and T2 time points (P < 0.05). The CI and EF values of groups C and D were increased at T1 time point but decreased at T2 time point in group D (P < 0.05). The incidence of hypertension and tachycardia in group A was significantly higher than that in group C and group D (P < 0.05), and the incidence of hypotension and bradycardia in group D was significantly higher than that in group A and group B (P < 0.05).
Alfentanil 20 µg/kg for RSI in elderly patients, can effectively inhibit the violent cardiovascular reaction caused by intubation, and avoid the inhibition of cardiovascular system caused by large dose, hemodynamics more stable.
ChiCTR2200062034 ( www.chictr.org.cn ).
在麻醉诱导和气管插管期间，快速序贯插管（RSI）已被证明可有效预防饱腹患者的反流误吸。然而，目前对于 RSI 没有标准化的操作方案或麻醉诱导药物标准。此外，对于 65 岁以上患者使用 RSI 的证据也不足。在这项研究中，我们旨在研究不同剂量的阿芬太尼联合异丙酚和依托咪酯在 65-80 岁老年患者 RSI 中的心血管效应。
选择 96 名 65-80 岁接受全身麻醉和气管插管的患者进行本研究。患者采用随机数字表法随机分为四组。A 组患者给予 10μg/kg 阿芬太尼诱导剂量，B 组患者给予 15μg/kg 阿芬太尼，C 组患者给予 20μg/kg 阿芬太尼，D 组患者给予 25μg/kg 阿芬太尼。在三个时间点测量心率（HR）、平均动脉压（MAP）、心指数（CI）和射血分数（EF）：麻醉诱导前 5 分钟（T0）、气管插管后 1 分钟（T1）和气管插管后 5 分钟（T2）。同时，在三个时间点从患者采集 4ml 动脉血，检测血浆中去甲肾上腺素（NE）和皮质醇（Cor）的浓度。记录麻醉诱导至气管插管后 5 分钟期间高血压、低血压、心动过缓和心动过速的发生情况。
与 T0 相比，A 组和 B 组在 T1 和 T2 时间点 HR、MAP、NE 和 Cor 浓度升高，CI 和 EF 值降低（P<0.05）。C 组和 D 组在 T1 时间点 HR 和 MAP 升高，而 D 组在 T2 时间点 HR 和 MAP 降低（P<0.05）。C 组在 T1 和 T2 时间点 CI 和 EF 值、NE 和 Cor 浓度变化不显著（P>0.05）。D 组在 T1 时间点变化不显著（P>0.05），但在 T2 时间点降低（P<0.05）。与 A 组相比，C 组和 D 组在 T1 和 T2 时间点 HR、MAP、NE 和 Cor 浓度降低（P<0.05）。C 组和 D 组在 T1 时间点 CI 和 EF 值升高，但 D 组在 T2 时间点 CI 和 EF 值降低（P<0.05）。A 组高血压和心动过速的发生率明显高于 C 组和 D 组（P<0.05），D 组低血压和心动过缓的发生率明显高于 A 组和 B 组（P<0.05）。
在老年患者中，阿芬太尼 20μg/kg 用于 RSI 可有效抑制插管引起的剧烈心血管反应，避免大剂量引起的心血管系统抑制，血流动力学更稳定。
ChiCTR2200062034（www.chictr.org.cn）。
